Medicine (St Vincent's) - Research Publications

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    Vitamin D status in patients with frontal fibrosing alopecia: A retrospective study.
    Arasu, A ; Meah, N ; Eisman, S ; Wall, D ; Sinclair, R (Elsevier BV, 2022-06)
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    Comparing abrocitinib and dupilumab in the treatment of atopic dermatitis: a plain language summary.
    Bieber, T ; Simpson, EL ; Silverberg, JI ; Thaçi, D ; Paul, C ; Pink, AE ; Kataoka, Y ; Chu, C-Y ; DiBonaventura, M ; Rojo, R ; Antinew, J ; Ionita, I ; Sinclair, R ; Forman, S ; Zdybski, J ; Biswas, P ; Malhotra, B ; Zhang, F ; Valdez, H (Future Medicine Ltd, 2022-01)
    Atopic dermatitis (AD, also called atopic eczema) is a long-term skin disease that causes intensely itchy, red skin. Healthcare providers can prescribe medicated creams and ointments to reduce the signs and symptoms of AD. However, these treatments are not always enough to provide relief. A new medicine called abrocitinib, which is taken every day as a tablet, reduces part of the body's immune response that happens in AD. The clinical study described in this plain language summary, called JADE COMPARE, investigated how well and how safely 16 weeks of treatment with abrocitinib worked in adults with AD compared to placebo ('dummy treatment') and a medicine that is already approved for AD, called dupilumab. The study showed that abrocitinib was better than placebo in improving the signs and symptoms of AD after 16 weeks. In addition, patients who were taking abrocitinib 200 mg for 2 weeks experienced greater relief from itch than patients who were taking abrocitinib 100 mg, placebo, or dupilumab. More people who took abrocitinib 200 mg reported side effects than those taking abrocitinib 100 mg, placebo, or dupilumab, but most of these side effects were mild or moderate. ClinicalTrials.gov NCT number: NCT03720470.
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    Efficiency of Hair Detection in Hair-to-Hair Matched Trichoscopy
    Bokhari, L ; Cottle, P ; Grimalt, R ; Kasprzak, M ; Sicinska, J ; Sinclair, R ; Tosti, A (KARGER, 2022-05-12)
    INTRODUCTION: Precise evaluation of changes in hair count is crucial for monitoring progression of hair loss and the effects of treatment. The focus of this study is the comparison of the various examination and assessment techniques in terms of the precision of hair count change observed in trichoscopy images. METHODS: Controlled hair extraction of the same scalp spot was used to simulate hair loss, and the different examination techniques were performed to detect this change. The investigators who performed the counting were blinded. RESULTS: For trichoscopy images, the average error in determining the terminal hair count change (relative to total hair count) was 9 ± 1% for automatic assessment with manual correction and 0.4 ± 0.2% for hair-to-hair matched images. For phototrichogram, the automatic measurement results were found to deviate from truth on average by 12 ± 2%. The manually corrected hair count results were much closer to the truth with average deviation at the level of 7 ± 1%. The hair-to-hair matched results corresponded to approximately 0.6 ± 0.3% average discrepancy. CONCLUSION: Combination of manually corrected image processing, follicular mapping, and hair-to-hair matching appears to be the most precise way of evaluating the change in hair count over time. These novel techniques should be considered valuable, especially in research and clinical trials.
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    Maintenance, withdrawal, and re-treatment with ritlecitinib and brepocitinib in patients with alopecia areata in a single-blind extension of a phase 2a randomized clinical trial.
    Peeva, E ; Guttman-Yassky, E ; Banerjee, A ; Sinclair, R ; Cox, LA ; Zhu, L ; Zhu, H ; Vincent, M ; King, B (Elsevier BV, 2022-08)
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    Defining Severity in Alopecia Areata: Current Perspectives and a Multidimensional Framework.
    King, BA ; Senna, MM ; Ohyama, M ; Tosti, A ; Sinclair, RD ; Ball, S ; Ko, JM ; Glashofer, M ; Pirmez, R ; Shapiro, J (Springer Science and Business Media LLC, 2022-04)
    Alopecia areata (AA) is an autoimmune disease characterized by nonscarring hair loss. As a clinically heterogeneous disease, various classification systems have evolved for defining its severity. In this high-level review of the literature, we discuss the traditional classification systems for AA severity and their strengths and weaknesses. Most recent classifications have focused on the extent of scalp hair loss as a defining feature, but additional clinical aspects of the disease, including location, pattern, and duration of hair loss as well as impact on the patient's quality of life, are also relevant. These various components have typically been used unidimensionally to classify patients. We propose a multidimensional framework to define AA severity that incorporates multiple patient- and illness-related domains. Using such a framework, dermatologists may better assess the severity of the disease for the individual patient beyond the extent of hair loss.
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    Once-Daily Roflumilast Foam 0.3% Improves Severity and Burden of Itch in Patients With Scalp and Body Psoriasis in a Randomized, Double-blind, Vehicle-Controlled Phase 2b Study
    Moore, A ; Alonso-Llamazares, J ; Bhatia, N ; Devani, A ; Bukhalo, M ; Draelos, Z ; Gooderham, M ; Kempers, S ; Kircik, L ; Papp, K ; Pariser, D ; Sankeva, M ; Sinclair, R ; Zirwas, M ; Feng, A ; Burnett, P ; Higham, R ; Berk, D (National Society for Cutaneous Medicine, 2021-11-05)
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    Advances in hair growth.
    Wall, D ; Meah, N ; Fagan, N ; York, K ; Sinclair, R (Faculty Opinions Ltd, 2022)
    Hair is a deeply rooted component of identity and culture. Recent articles in this series have focused on scientific evidence relating to hair growth and new insights into the pathogenesis and mechanism of hair loss. This article reviews emerging evidence that has advanced our understanding of hair growth in both of these areas to provide a context for outlining current and emerging therapies. These include finasteride, minoxidil, topical prostaglandins, natural supplements, microneedling, low-level laser light, platelet-rich plasma, fractional lasers, cellular therapy, Wnt activators and SFRP1 antagonism.
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    Female pattern hair loss: a pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone
    Sinclair, RD (WILEY, 2018-01-01)
    BACKGROUND: Minoxidil and spironolactone are oral antihypertensives known to stimulate hair growth. OBJECTIVE: To report on a case series of women with pattern hair loss (PHL) treated with once daily minoxidil 0.25 mg and spironolactone 25 mg. METHODS: Women newly diagnosed with a Sinclair stage 2-5 PHL were scored for hair shedding and hair density before and after 12 months of treatment with oral minoxidil 0.25 mg and spironolactone 25 mg. RESULTS: A total of 100 women were included in this observational pilot study. Mean age was 48.44 years (range 18-80). Mean hair loss severity at baseline was Sinclair 2.79 (range 2-5). Mean hair shedding score at baseline was 4.82. Mean duration of diagnosis was 6.5 years (range 0.5-30). Mean reduction in hair loss severity score was 0.85 at 6 months and 1.3 at 12 months. Mean reduction in hair shedding score was 2.3 at 6 months and 2.6 at 12 months. Mean change in blood pressure was -4.52 mmHg systolic and -6.48 mmHg diastolic. Side effects were seen in eight women but were generally mild. No patients developed hyperkalemia or any other blood test abnormality. Six of these women continued treatment, and two women who developed urticaria discontinued treatment. LIMITATIONS: Prospective, uncontrolled, open-label observational study. DISCUSSION: Once daily capsules containing minoxidil 0.25 mg and spironolactone 25 mg appear to be safe and effective in the treatment of FPHL. Placebo-controlled studies to investigate this further are warranted.
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    Styling without shedding: Novel topical formula reduces hair shedding by contracting the arrector pili muscle
    McCoy, J ; Goren, A ; Kovacevic, M ; Situm, M ; Stanimirovic, A ; Shapiro, J ; Sinclair, R (WILEY, 2018-01-01)
    Approximately 40% of women experience excessive hair shedding during styling (e.g., hair brushing). Previously, we demonstrated that topically applied phenylephrine, a potent α1 adrenergic receptor agonist, can be used to contract the arrector pili muscle of the follicular unit; thus, increasing the force required to pluck hair and reducing shedding during brushing. While demonstrating efficacy, phenylephrine has several drawbacks when applied to the scalp, including the possibility cardiovascular events. We hypothesized that a high concentration of a weak α1 agonist would allow for: (a) rapid penetration through the stratum corneum eliciting a quick response; (b) a low probability of cardiac adverse events owing to the low receptor binding affinity; and (c) an efficacy of the weak α1 agonist similar to that of phenylephrine at the local site of application. Accordingly, we developed a novel topical solution, AB-102, containing a high concentration of a weak α1 agonist. Several studies were conducted to test the safety and efficacy of AB-102. In a dose escalating safety study, utilizing a wearable holter monitor, we observed no cardiac or hemodynamic adverse events. In addition, in a controlled efficacy study, AB-102 reduced the number of hairs shed during brushing by up to 77% (average of 38%).
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    Development and validation of the International Hidradenitis Suppurativa Severity Score System (IHS4), a novel dynamic scoring system to assess HS severity
    Zouboulis, CC ; Tzellos, T ; Kyrgidis, A ; Jemec, GBE ; Bechara, FG ; Giamarellos-Bourboulis, EJ ; Ingram, JR ; Kanni, T ; Karagiannidis, I ; Martorell, A ; Matusiak, L ; Pinter, A ; Prens, EP ; Presser, D ; Schneider-Burrus, S ; von Stebut, E ; Szepietowski, JC ; van der Zee, HH ; Wilden, SM ; Sabat, R (WILEY, 2017-11-01)
    BACKGROUND: A validated tool for the dynamic severity assessment of hidradenitis suppurativa/acne inversa (HS) is lacking. OBJECTIVES: To develop and validate a novel dynamic scoring system to assess the severity of HS. METHODS: A Delphi voting procedure was conducted among the members of the European Hidradenitis Suppurativa Foundation (EHSF) to achieve consensus towards an initial HS Severity Score System (HS4). Strengths and weaknesses of HS4 were examined by a multicentre prospective study. Multivariate logistic regression, discriminant analysis and receiver operating characteristic curves, as well as examination for correlation (Spearman's rho) and agreement (Cohen's kappa) with existing scores, were engaged to recognize the variables for a new International HS4 (IHS4) that was established by a second Delphi round. RESULTS: Consensus HS4 was based on number of skin lesions, number of skin areas involved and Dermatology Life Quality Index (DLQI), and was evaluated by a sample of 236 patients from 11 centres. Subsequently, a multivariate regression model calculated adjusted odds ratios for several clinical signs. Nodules, abscesses and draining tunnels resulted as the scoring variables. Three candidate scores were presented to the second Delphi round. The resulting IHS4 score is arrived at by the number of nodules (multiplied by 1) plus the number of abscesses (multiplied by 2) plus the number of draining tunnels (multiplied by 4). A total score of 3 or less signifies mild, 4-10 signifies moderate and 11 or higher signifies severe disease. Cohen's kappa was fair (κ = 0·32) compared with Hurley classification, and moderate (κ = 0·49) compared with Expert Opinion. Correlation was good (ρ > 0·6) with Hurley classification, Expert Opinion, Physician's Global Assessment and Modified Sartorius score, and moderate for DLQI (ρ = 0·36). CONCLUSIONS: The novel IHS4 is a validated tool to dynamically assess HS severity and can be used both in real-life and the clinical trials setting.